UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Diagnosis of and screening for hypothyroidism in nonpregnant adults

Author
Douglas S Ross, MD
Section Editor
David S Cooper, MD
Deputy Editor
Jean E Mulder, MD

INTRODUCTION

The diagnosis of hypothyroidism relies heavily upon laboratory tests because of the lack of specificity of the typical clinical manifestations. Primary hypothyroidism is characterized by a high serum thyroid-stimulating hormone (TSH) concentration and a low serum free thyroxine (T4) concentration, whereas subclinical hypothyroidism is defined biochemically as a normal free T4 concentration in the presence of an elevated TSH concentration. Secondary (central) hypothyroidism is characterized by a low serum T4 concentration and a serum TSH concentration that is not appropriately elevated.

This topic will review diagnosis of and screening for hypothyroidism in nonpregnant adults. Screening for hypothyroidism during pregnancy and in neonates is reviewed separately. (See "Hypothyroidism during pregnancy: Clinical manifestations, diagnosis, and treatment", section on 'Screening' and "Clinical features and detection of congenital hypothyroidism", section on 'Newborn screening'.)

The major clinical manifestations, causes, and treatment of hypothyroidism, and the diagnosis and management of subclinical hypothyroidism are discussed separately. (See "Clinical manifestations of hypothyroidism" and "Disorders that cause hypothyroidism" and "Treatment of hypothyroidism" and "Subclinical hypothyroidism in nonpregnant adults".)

EPIDEMIOLOGY

In community surveys, the prevalence of overt hypothyroidism varies from 0.1 to 2 percent [1-5]. The prevalence of subclinical hypothyroidism is higher, ranging from 4 to 10 percent of adults, with possibly a higher frequency in older women [1,2,6,7]. However, there is an age-related shift towards higher thyroid-stimulating hormone (TSH) concentrations in older patients and, therefore, if age-adjusted normal ranges are used, the prevalence may not increase with old age. (See "Laboratory assessment of thyroid function", section on 'Serum TSH concentration'.)

Hypothyroidism is five to eight times more common in women than men, and more common in women with small body size at birth and during childhood [5,8].

                 

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Nov 2016. | This topic last updated: Mon Dec 14 00:00:00 GMT 2015.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
References
Top
  1. Tunbridge WM, Evered DC, Hall R, et al. The spectrum of thyroid disease in a community: the Whickham survey. Clin Endocrinol (Oxf) 1977; 7:481.
  2. Vanderpump MP, Tunbridge WM, French JM, et al. The incidence of thyroid disorders in the community: a twenty-year follow-up of the Whickham Survey. Clin Endocrinol (Oxf) 1995; 43:55.
  3. Vanderpump MP, Tunbridge WM. The epidemiology of thyroid diseases. In: The thyroid: A fundamental and clinical text, 8th, Braverman LE, Utiger RD (Eds), Lippincott Williams and Wilkins, Philadelphia 2000. p.467.
  4. Canaris GJ, Manowitz NR, Mayor G, Ridgway EC. The Colorado thyroid disease prevalence study. Arch Intern Med 2000; 160:526.
  5. Aoki Y, Belin RM, Clickner R, et al. Serum TSH and total T4 in the United States population and their association with participant characteristics: National Health and Nutrition Examination Survey (NHANES 1999-2002). Thyroid 2007; 17:1211.
  6. Hollowell JG, Staehling NW, Flanders WD, et al. Serum TSH, T(4), and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III). J Clin Endocrinol Metab 2002; 87:489.
  7. Walsh JP, Bremner AP, Feddema P, et al. Thyrotropin and thyroid antibodies as predictors of hypothyroidism: a 13-year, longitudinal study of a community-based cohort using current immunoassay techniques. J Clin Endocrinol Metab 2010; 95:1095.
  8. Kajantie E, Phillips DI, Osmond C, et al. Spontaneous hypothyroidism in adult women is predicted by small body size at birth and during childhood. J Clin Endocrinol Metab 2006; 91:4953.
  9. McDermott MT. In the clinic. Hypothyroidism. Ann Intern Med 2009; 151:ITC61.
  10. Surks MI, Hollowell JG. Age-specific distribution of serum thyrotropin and antithyroid antibodies in the US population: implications for the prevalence of subclinical hypothyroidism. J Clin Endocrinol Metab 2007; 92:4575.
  11. Samuels MH, Ridgway EC. Central hypothyroidism. Endocrinol Metab Clin North Am 1992; 21:903.
  12. Lania A, Persani L, Beck-Peccoz P. Central hypothyroidism. Pituitary 2008; 11:181.
  13. Beck-Peccoz P, Amr S, Menezes-Ferreira MM, et al. Decreased receptor binding of biologically inactive thyrotropin in central hypothyroidism. Effect of treatment with thyrotropin-releasing hormone. N Engl J Med 1985; 312:1085.
  14. Topliss DJ, White EL, Stockigt JR. Significance of thyrotropin excess in untreated primary adrenal insufficiency. J Clin Endocrinol Metab 1980; 50:52.
  15. Kahn BB, Weintraub BD, Csako G, Zweig MH. Factitious elevation of thyrotropin in a new ultrasensitive assay: implications for the use of monoclonal antibodies in "sandwich" immunoassay. J Clin Endocrinol Metab 1988; 66:526.
  16. Loh TP, Kao SL, Halsall DJ, et al. Macro-thyrotropin: a case report and review of literature. J Clin Endocrinol Metab 2012; 97:1823.
  17. Tonacchera M, Di Cosmo C, De Marco G, et al. Identification of TSH receptor mutations in three families with resistance to TSH. Clin Endocrinol (Oxf) 2007; 67:712.
  18. Mariotti S, Caturegli P, Piccolo P, et al. Antithyroid peroxidase autoantibodies in thyroid diseases. J Clin Endocrinol Metab 1990; 71:661.
  19. Danese MD, Powe NR, Sawin CT, Ladenson PW. Screening for mild thyroid failure at the periodic health examination: a decision and cost-effectiveness analysis. JAMA 1996; 276:285.
  20. Gussekloo J, van Exel E, de Craen AJ, et al. Thyroid status, disability and cognitive function, and survival in old age. JAMA 2004; 292:2591.
  21. Surks MI, Ortiz E, Daniels GH, et al. Subclinical thyroid disease: scientific review and guidelines for diagnosis and management. JAMA 2004; 291:228.
  22. Gharib H, Tuttle RM, Baskin HJ, et al. Subclinical thyroid dysfunction: a joint statement on management from the American Association of Clinical Endocrinologists, the American Thyroid Association, and the Endocrine Society. J Clin Endocrinol Metab 2005; 90:581.
  23. Spencer CA. Clinical utility and cost-effectiveness of sensitive thyrotropin assays in ambulatory and hospitalized patients. Mayo Clin Proc 1988; 63:1214.
  24. American Academy of Family Physicians. Summary of policy recommendations for periodic health examinations. Leawood, KS: American Academy of Family Physicians, 2002.
  25. Clinical guideline, part 1. Screening for thyroid disease. American College of Physicians. Ann Intern Med 1998; 129:141.
  26. Garber JR, Cobin RH, Gharib H, et al. Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Thyroid 2012; 22:1200.
  27. Rugge JB, Bougatsos C, Chou R. Screening and treatment of thyroid dysfunction: an evidence review for the U.S. Preventive Services Task Force. Ann Intern Med 2015; 162:35.
  28. LeFevre ML, U.S. Preventive Services Task Force. Screening for thyroid dysfunction: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2015; 162:641.